Document Detail


Less-invasive perfusion techniques may improve outcome in thoracoabdominal aortic surgery.
MedLine Citation:
PMID:  20346468     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The study compared the short-term outcome of distal perfusion in thoracoabdominal aortic aneurysm surgery using a mini-circuit and nonocclusive femoral cannulation with a traditional setup using a roller pump and occlusive cannulation.
METHODS: A total of 120 consecutive patients undergoing thoracoabdominal aortic aneurysm repair with femoro-femoral distal perfusion from 2005 to 2008 were included in this retrospective study. Perfusion was accomplished with either a mini-circuit (centrifugal pump, low priming volume, heparin coating) and nonocclusive femoral cannulation (N = 48, group A) or conventional roller pump and occlusive cannulation (N = 72, group B). Parameters representing tissue damage or ischemia (lactate dehydrogenase, creatine kinase, myoglobin, creatinine, glomerular filtration rate) were monitored intraoperatively and postoperatively and compared.
RESULTS: One patient from each group required renal dialysis postoperatively. Myoglobin values were similar in both groups. Creatine kinase was significantly higher in group B (P < .001). Hemolysis represented from lactate dehydrogenase was higher in group B (P = .005). Both the traditional setup and the mini-circuit achieved a return to preoperative glomerular filtration rate by postoperative day 10 with a significantly higher decrease of glomerular filtration rate within 10 days in group B.
CONCLUSIONS: The use of mini-circuits for thoracoabdominal aortic aneurysm surgery is safe. Compared with patients undergoing suprarenal clamping for abdominal aortic aneurysm, distal and organ perfusion in thoracoabdominal aortic aneurysm surgery maintain renal function independently of the technical setup. An initial decay of glomerular filtration rate on postoperative days 1 to 4, however, seems to be related to intraoperative leg ischemia and hemolysis caused by occlusive cannulation of the femoral vessels and the roller pump. Whether this has an effect on long-term outcome remains to be seen.
Authors:
Theodosios Bisdas; Ahmed Redwan; Mathias Wilhelmi; Axel Haverich; Christian Hagl; Omke Teebken; Maximilian Pichlmaier
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-03-25
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  140     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-16     Completed Date:  2010-12-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1319-24     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. Bisdas.Theodosios@MH-Hannover.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aortic Aneurysm, Thoracic / surgery*
Biological Markers / blood
Comorbidity
Extracorporeal Circulation / instrumentation*
Female
Femoral Artery
Femoral Vein
Glomerular Filtration Rate
Humans
Male
Middle Aged
Statistics, Nonparametric
Treatment Outcome
Vascular Surgical Procedures / methods*
Chemical
Reg. No./Substance:
0/Biological Markers

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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